Nursing Home Case Manager / RN

The Case Manager combines nursing knowledge and skills to manage the skilled residents’ stay from admission to discharge. Works closely with the interdisciplinary team to complete comprehensive reviews with insurance companies to ensure the optimal benefit for the residents. Provide nursing and administrative leadership support to assist in guiding the staff with all aspects of the operation (customer service support, compliance with regulatory standards, consistency with implementation of facility policies and procedures).

ESSENTIAL JOB FUNCTIONS:

• Conduct resident intake assessments, including but not limited to a detailed medical history, diagnosis’, medication regimen, therapy needs and discharge plan;
• Work closely with interdisciplinary care team to manage skilled residents stay from admission to discharge; manage care, including referral management, care planning, post-discharge planning and coordinating community-based and transitional care;
• Conduct ongoing individualized clinical evaluations of residents, their health needs and concerns; develop personalized action plans, provide education and issue referrals for care management programs; monitor residents’ progress in meeting established goals and modify care plans accordingly;
• Use evidence-based, comprehensive care plans to manage patients;
• Develop a cohesive and strong team-oriented relationship with physicians, nurses and other healthcare professionals; evaluate and report on resident health outcomes and work in partnership with interdisciplinary healthcare team to facilitate the best in resident care and to ensure the Resident Assessment Coordinator has the information needed to complete the MDS appropriately;
• Direct discharge planning process in support of treatment adherence and medication compliance; assist with transitions for residents discharged from the skilled nursing facility to the least restrictive environment;
• Guide, intervene and advocate on behalf of residents, their caregivers and/or families with regards to navigating and comprehending the healthcare system; coordinate resources in the community to ease transition;
• Complete reviews with insurance agencies ensuring a comprehensive assessment is detailed including medication review, medical history, discharge plan and therapy needs and progress to ensure the optimal usage of the insurance plan;
• Responsible to deliver notice of non-coverage and assist with appeals as needed;
• Be familiar with a variety of field concepts, practices and procedures;
• Assist with nursing staff education in the documentation MDS, RAP, Care Plans and ADL Charting;
• Must accurately complete MDS assessments in accordance with established time frames for new admissions, quarterly, annual and significant change as needed;
• Must pre-check and electronically submit MDS’s to State agency, review validation reports and make necessary changes as needed;
• Coordinates the scheduling and timely completion of MDS’s and Care Plans with the Interdisciplinary team;
• Participates in the QA process;
• Prepares action plans to correct anticipated problems, and effectively address unexpected issues as they arise;
• Be compatible and knowledgeable in the functionality of EMR software;
• Provide guests service support.

EXPERIENCE:

• 3 – 5 years experience as an RNAC in a Skilled Nursing Facility, preferred.
• Licensed as a registered nurse in Pennsylvania, preferred, but an LPN with 3 – 5 years of LNAC experience may be considered as well.
• Must maintain current certifications in CPR and First Aid.

BENEFITS:

• Highmark BC/BS Medical Insurance with employee-only coverage costing only $40/ month!
• Full Family Medical Insurance is only $250/month!
• Employees with LECOM Medical Insurance can take advantage of waived co-pays and deductibles at LECOM physicians and Millcreek Community Hospital.
• 403(b) Retirement Plan with Employer Matching of 100% after completing one year of service
• Life Insurance and AD&D Insurance is provided to all Full Time employees at no cost!
• Paid time off accruals – vacation and sick
• 7 paid holidays each calendar year
• Life Insurance and AD&D Insurance is provided to all Full Time employees at no cost!
• Employee referral program
• Employee appreciation/recognition events

TUITION REIMBURSEMENT:

The RN and LPN Tuition Reimbursement Program was created to assist LECOM Health employees by offsetting a portion of their educational expenses. Registered Nurses or Licensed Practical Nurses may be eligible for tuition reimbursement up to a maximum of $22,000.*

LECOM is an equal opportunity employer.

*The Tuition Reimbursement Program is a taxable benefit. LECOM Health reserves the right to modify or terminate this program, in whole or in part, in such manner as it shall determine, either alone or in conjunction with other programs of LECOM. Modification or termination may be made by the company for any reason, including but not limited to modifications under the Internal Revenue Code.